The effect of real time medication monitoring- based digital adherence tools on adherence to antiretroviral therapy and viral suppression in people living with HIV: a systematic literature review and meta-analyses

Abstract

Background: Universal antiretroviral therapy (ART) has led to improved treatment outcomes in personsliving with HIV (PLHIV). Adherence to ART is required to achieve viral suppression. Realtime medication monitoring (RTMM) based digital adherence tools (DATs) could be effectivein improving ART adherence and viral suppression in PLHIV. Objectives: The primary and secondary objectives of this review were to assess the effect ofRTMM-based DATs on improving ART adherence and viral load suppression. Methods: We searched the MEDLINE, Embase and Global Health for publications published through11 October 2022. Narrative synthesis and random effects meta-analyses were conducted tosynthesise results. Results: Out of 638 papers identified, eight were included. Six studies were randomised controlledtrials (RCTs), and two were cohort studies. Two studies, a RCT in China (mean adherence:96.2% vs 89.1%) and a crossover cohort study in Uganda (mean adherence: 84% vs 93%),demonstrated improved ART adherence. No studies demonstrated improved viralsuppression. In the meta-analyses, we estimated that RTMM-based digital adherence toolshad statistically insignificant small positive effect on ART adherence and viral suppressionwith a standardised mean difference of 0.1922 [95% CI: -0.0268 – 0.4112, p-value: 0.0854]and viral suppression with an odds ratio of 1.3148 [95% CI: 0.9199 – 1.8791, p-value:0.1331]. Conclusion: Our meta-analyses found that RTMM based DATs did not have a significant effect on ARTadherence and viral suppression. However, due to few published studies available,heterogeneity of target populations, intervention designs, and adherence measurementinstruments, more data are required to provide conclusive evidence.